But the “move fast and break things” mantra that has helped Silicon Valley disrupt countless industries over the last two decades is more dangerous when applied to medical science. The roadblocks that health tech companies run into are not qualitatively different from the ones that all tech companies run into. But when Uber or Airbnb run afoul of their respective laws, the result is abstracted lost money out of someone’s pocket — the government, independent contractors, independent businesses, other segments of the market. When Airbnb keeps viable apartments off the market so they can be rented short-term to its users, the money can theoretically be remanded if someone determines that Airbnb is doing something wrong. The “things” being broken by the current generation of unicorns are regulatory regimes. (Valuable, useful regulatory regimes, to be sure.) The “things” being broken by health start-ups are laws of science and ironclad guidelines for research. When a health start-up “moves fast and breaks things,” it can directly result in the death, dismemberment, and injury of real people. You can’t un-kill someone who died thanks to a bad diagnosis (at least, there’s no start-up hawking that yet).

While I don’t think this is wrong, I think it’s very incomplete. There are two significant differences between biotech and tech. The first is that much of tech does is “abstracted” (to use the author’s phrase). It is a virtualization or a simulation of the real world. In the case of Facebook or Twitter, it’s a construction out of whole cloth of a virtual reality (one that obviously draws on actual reality). As such, the rules can be rewritten. Unless one collides with regulators or some physical reality (Pets.com learned the hard way that shipping heavy bags of dog food to different locations one at a time is really expensive), it’s a ‘Green Lantern economy’: your magic slide deck or elevator pitch can be translated into (virtual) reality with enough smart programmers.

But biology, like Honey Badger, doesn’t give a shit. A cancerous cell will keep on metastasizing, aging will still happen, and so on. It’s analogous to what I once had to tell someone coming to terms with a new diagnosis of Crohn’s disease: you can fool your family and friends, you can fool the doctor, but you can’t fool your intestine.

That brings me to the second difference: natural history matters. In the day job, I work closely with computer scientists, who, on the whole, are very, very smart people. But there have been multiple occasions where either what appears to be an obvious solution will be hung up on those stupid fucking natural history facts, or what appears to be a difficult problem can be greatly simplified due to the biology. To be successful at biology, you have to know things (or listen to the people who do). That is, biological expertise matters–and it often has grey hair as well, something Silicon Valley disdains.

Just two more reasons why I think Silicon Valley has had biotech problems.